Role of regional anesthesia for placement of peritoneal dialysis catheter under ultrasound guidance: Our experience with 52 end-stage renal disease patients

Abstract

Aim:The number of patients with end-stage renal disease (ESRD) has shown a consistent rise in India in recent years. Continuous ambulatory peritoneal dialysis (CAPD) remains one of the safe and effective forms of treatment. In this study, we have tried to assess the effectiveness of field block technique for analgesia during catheter placement surgery until 24 h postoperatively, also, if it can obviate the need for general anesthesia in these high-risk patients.Materials and Methods:We studied 52 ESRD patients from 2010 to 2012 who were posted for CAPD catheterization in the Department of Urology, Care Hospital, Hyderabad, India. Under ultrasound guidance, “unilateral posterior” and “unilateral subcostal” transversus abdominis plane block anesthesia were given for the placement of CAPD catheter. Patient's intra-operative pain and post-operative pain were recorded with visual analog scores (VAS) and analyzed.Results:All patients in our study belonged to American Society of Anesthesiologists category 2 or 3 with multiple co-morbidities. 41 out of 52 patients required no supplemental analgesia during the procedure; 8 patients needed additional infiltration of local anesthetic during skin incisions. Three patients required supplemental analgesia and were considered as failure. A VAS of two was noted in 30 patients and 1 in 19 Patients. No Patient had significant pain 24 h post operatively. No local complication was noted in any patient.Conclusion:CAPD Catheterization under regional field block remains safe and effective options for ESRD patients.

A Randomized Controlled Trial of Comparing Ultrasound-Guided Transversus Abdominis Plane Block with Local Anesthetic Infiltration in Peritoneal Dialysis Catheter Implantation

“…The dosage of ropivacaine used in our study was similar or even lower when compared with that mentioned in the previous studies [20,21,23,24]. The blood level and safety range data of local anesthetic in TAP blocking is still lacking in ESRD patients, which demands to be explored in future studies.…”

“…Previous studies also showed remarkable analgesic effect of TAP block till 24 h after PDC implantation [20,21,23]. …”

“…All PDCs were implanted by open dissection as previously described [20,21] by 2 nephrologists in our PD center. All patients lay down in the supine position and a vertical paraumbilical incision was made 2 cm lateral to the umbilicus with 4-5 cm in length.…”

“…With the guidance of ultrasound, local anesthetics could be injected into TAP, where the thoracolumbar nerves (T7-L1) pass through to innervate the anterolateral abdominal wall, and result in its analgesic effect [15,16]. Recently, TAP block had been reported as a sole anesthesia technique in abdominal surgery in patients with high risks [17,18,19] and even in PDC implantation [20,21,22,23,24]. …”

Implantation of a peritoneal dialysis catheter in patients with ESRD using local anesthesia and Remifentanil

“…In recent years, the once hypothetical idea of peritoneal opening under local anesthetic infiltration became routine in many operating rooms around the world, saving a multi-morbid ESRD patient from the many risks of intubation [12]. This method is usually done through an ultrasound-guided Transversus abdominis plane (TAP) block, a method which has been thoroughly described and studied, and while feasible holds a high risk of conversion to general anesthesia (GA) [13][14][15][16][17]. Another approach also describes the laparoscopic insertion of the Tenckhoff catheter employing nitrous oxide to create a pneumoperitoneum under local anesthetic infiltration [18].…”